Prevalence and impact of comorbidities on disease prognosis among patients with COVID-19 in Bangladesh: A nationwide study amid the second wave

BackgroundSocio-demographics and comorbidities are involved in determining the severity and fatality in patients with COVID-19 suggested by studies in various countries, but study in Bangladesh is insufficient.AimsWe designed the study to evaluate the association of sociodemographic and comorbidities with the prognosis of adverse health outcomes in patients with COVID-19 in Bangladesh.MethodsA multivariate retrospective cohort study was conducted on data from 966 RT-PCR positive patients from eight divisions during December 13, 2020, to February 13, 2021. Variables included sociodemographic, comorbidities, symptoms, Charlson comorbidity index (CCI) and access to health facilities. Major outcome was fatality. Secondary outcomes included hospitalization, duration of hospital stay, requirement of mechanical ventilation and severity.ResultsMale (65.8%, 636 of 966) was predominant and mean age was 39.8 ± 12.6 years. Fever (79%), dry cough (55%), and loss of test/smell (51%) were frequent and 74% patients had >3 symptoms. Fatality was recorded in 10.5% patients. Comorbidities were found in 44% patients. Hypertension (21.5%) diabetes (14.6%), and cardiovascular diseases (11.3%) were most prevalent. Age >60 years (OR: 4.83, 95% CI: 2.45–6.49), and CCI >3 (OR: 5.48, 95% CI: 3.95–7.24) were predictors of hospitalizations. CCI >4 (aOR: 3.41, 95% CI: 2.57–6.09) was predictor of severity. Age >60 years (aOR: 3.77, 95% CI: 1.07–6.34), >3 symptoms (aOR: 2.14, 95% CI: 0.97–4.91) and CCI >3 vs. CCI <3 (aOR: 5.23, 95% CI: 3.77–8.09) were independently associated with fatality.ConclusionsIncreased age, >3 symptoms, increasing comorbidities, higher CCI were associated with increased hospitalization, severity and fatality in patients with COVID-19.     

Efficacy of naproxen in the management of patients hospitalized with COVID-19 infection: A randomized,double-blind,placebo-controlled,clinical trial

Background and aimsThe current study was done to examine the efficacy of naproxen in the management of patients with COVID-19 infection.MethodsThis randomized, double-blind, placebo-controlled, clinical trial was done on hospitalized adult patients with confirmed COVID-19 infection. Patients were randomly assigned to receive either naproxen (two capsules per day each containing 500 mg naproxen sodium) or placebo (containing starch) for five days along with the routine treatment that was nationally recommended for COVID-19 infection. Clinical symptoms of COVID-19 infection, the time to clinical improvement, blood pressure, laboratory parameters, and death due to COVID-19 infection were considered as the outcome variables in the present study.ResultsTreatment with naproxen improved cough and shortness of breath in COVID-19 patients; such that, compared with placebo, naproxen intake was associated with 2.90 (95% CI: 1.10–7.66) and 2.82 (95% CI: 1.05–7.55) times more improvement in cough and shortness of breath, respectively. In addition, naproxen administration resulted in a significant increase in mean corpuscular volume (MCV) and had a preventive effect on the reduction of systolic blood pressure in COVID-19 patients.ConclusionTreatment with naproxen can improve cough and shortness of breath in COVID-19-infected patients. Further studies are required to confirm our findings.     

Metabolic syndrome and the risk of COVID-19 infection: A nationwide population-based case-control study

Background and aimsMetabolic syndrome (MetS) is a chronic, low-grade inflammatory disease. This study aimed to investigate the impact of MetS on the risk and severity of COVID-19.Methods and resultsWe investigated a nationwide cohort with COVID-19 including all patients who underwent the test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Korea. The COVID-19 group included 4070 patients with positive SARS-CoV-2 test results, and the age- and sex-matched control group included 27,618 subjects with negative SARS-CoV-2 test results. The endpoints were SARS-CoV-2 positivity and the severity of COVID-19. The prevalence of MetS was 24.7% and 24.5% in the COVID-19 and control groups, respectively. The presence of MetS was not associated with the risk of developing COVID-19. Among the components of MetS, central obesity was associated with a higher risk of COVID-19 infection (adjusted odds ratio [aOR], 1.17; 95% confidence interval [CI], 1.06–1.28, P = 0.001). The presence of MetS was significantly associated with severe COVID-19 (aOR, 1.25; 95% CI, 0.78–2.00, P = 0.352). Among the individual components of MetS, prediabetes/diabetes mellitus was associated with a higher risk of severe COVID-19 (aOR, 1.61; 95% CI, 1.21–2.13, P = 0.001). The risk of severe COVID-19 linearly increased according to the number of metabolic components (P for trend = 0.005).ConclusionIn this nationwide cohort study, the individuals with MetS had a significant increase in the risk of severe COVID-19 infection. These patients, particularly those with central obesity and insulin resistance, deserve special attention amid the COVID-19 pandemic.     

Effect of pandemic on DOTS treatment during COVID-19 lockdown- A cross-sectional study

BackgroundTuberculosis (TB) is still the most common infectious disease globally, affecting 1.5 million people per year. Prior to COVID-19 outbreak, India was struggling with a rampant attack of Tuberculosis. With the surge of COVID-19 implementation of all national health programs including NTEP was disrupted. Prioritization of services, the challenges to reaching all types of communities and the role of stigmatization, and the possibility of increased disease transmission were few problems in the implementation of DOTS during the lockdown.AimTo assess effect of pandemic on DOTS treatment during COVID-19 lockdown.MethodsA cross-sectional study was conducted among 254 tuberculosis patients who were under DOTS during Covid-19 lockdown in Belagavi district. Participants who were on DOTS during 2019–2021 period.ResultOf 254 participants, only 5 (2.0%) were supervised while taking drugs, 67 (26.4%) of subject's empty blister packs were taken back by health personnel and 106 (41.7%) participants were regularly followed up for treatment by health department. The variables like gender, literacy status, socioeconomic status, and occupation were all significantly associated with hampered access to DOTS during the lockdown period at p < 0.05.ConclusionThis study concluded that the participants had hampered accessibilities to DOTS during lockdown.     

Knowledge,attitude and practice of patients with chronic diseases towards COVID-19 pandemic in Dessie town hospitals,Northeast Ethiopia

Background and aimsCorona virus disease-19 first detected in China, December 2019. The government of Ethiopia takes preventive measures but the number of peoples infected with COVID-19 has been increased. Control of the pandemic requires changing of knowledge, attitude and practice of people. Hence, the objective of this study was to assess chronic disease patients’ knowledge, attitude and practice towards COVID-19 pandemic.MethodsInstitution based cross-sectional study was done among 413 chronic disease patients from July 20 to August 5, 2020 in Dessie town hospitals. Multinomial logistic regression analysis was used and significant association declared at p-value of <0.05.ResultsFrom the total participants 34.6%, 81.4% and 40.7% had good knowledge, attitude and practice while 35.1%, 12.1% and 24.7% had moderate knowledge, attitude and practice towards COVID-19 pandemic, respectively. In multinomial logistic regression young age, urban residency, attainment of secondary education and presence of additional co-morbidity were predictors of moderate knowledge whereas urban residency, not attended formal education and presence of additional co-morbidity were predictors of good knowledge about COVID-19. Household family size and presence of additional co-morbidity were factors significantly associated with moderate practice of COVID-19 prevention methods. Furthermore, male sex, household family size, knowledge of COVID-19 and attitude towards COVID-19 were factors significantly associated with good practice of COVID-19 prevention methods.ConclusionSignificant number of chronic disease patients had poor knowledge and practice towards COVID-19. Therefore, government, health professionals, Medias, researchers and health institution should do to improve the gaps of chronic diseases patients.     

Non-alcoholic fatty liver disease and clinical outcomes in patients with COVID-19: A comprehensive systematic review and meta-analysis

BackgroundNon-alcoholic fatty liver disease (NAFLD) patients represent a vulnerable population that may be susceptible to more severe COVID-19. Moreover, not only the underlying NAFLD may influence the progression of COVID-19, but the COVID-19 may affect the clinical course of NAFLD as well. However, comprehensive evidence on clinical outcomes in patients with NAFLD is not well characterized.ObjectivesTo systematically review and meta-analysis the evidence on clinical outcomes in NAFLD patients with COVID-19.MethodsMEDLINE, EMBASE, and Cochrane Central were searched from inception through November 2020. Epidemiological studies assessing the clinical outcomes in COVID-19 patients with NAFLD were included. Newcastle-Ottawa Scale (NOS) was used to assess study quality. Generic inverse variance method using RevMan was used to determine the pooled estimates using the random-effects model.ResultsFourteen studies consisting of 1851 NAFLD patients, were included. Significant heterogeneity was observed among the studies, and studies were of moderate to high quality [mean, (range):8 (6, 8)]. For NAFLD patients, the adjusted odds ratio (aOR) for the severe COVID-19 was 2.60 (95%CI:2.24–3.02; p < 0.001) (studies,n:8), aOR for admission to ICU due to COVID-19 was 1.66 (95%CI:1.26–2.20; p < 0.001) (studies,n:2), and aOR for mortality for was 1.01 (95%CI:0.65–1.58; p = 0.96) (studies,n:2).ConclusionsAn increased risk of severe COVID-19 infection and admission to ICU due to COVID-19 with no difference in mortality was observed between NAFLD and non-NAFLD patients. Future studies should include the mortality outcome to conclusively elucidate the impact of NAFLD in patients with COVID-19.     

Risk perception and knowledge of COVID-19 in patients with celiac disease

BACKGROUNDWe recently demonstrated that the odds of contracting coronavirus disease 2019 (COVID-19) in patients with celiac disease (CeD) is similar to that of the general population. However, how patients with CeD perceive their COVID-19 risk may differ from their actual risk.AIMTo investigate risk perceptions of contracting COVID-19 in patients with CeD and determine the factors that may influence their perception.METHODSWe distributed a survey throughout 10 countries between March and June 2020 and collected data on demographics, diet, COVID-19 testing, and risk perceptions of COVID-19 in patients with CeD. Participants were recruited through various celiac associations, clinic visits, and social media. Risk perception was assessed by asking individuals whether they believe patients with CeD are at an increased risk of contracting COVID-19 when compared to the general population. Logistic regression was used to determine the influencing factors associated with COVID-19 risk perception, such as age, sex, adherence to a gluten-free diet (GFD), and comorbidities such as cardiac conditions, respiratory conditions, and diabetes. Data was presented as adjusted odds ratios (aORs)RESULTSA total of 10737 participants with CeD completed the survey. From them, 6019 (56.1%) patients with CeD perceived they were at a higher risk or were unsure if they were at a higher risk of contracting COVID-19 compared to the non-CeD population. A greater proportion of patients with CeD perceived an increased risk of contracting COVID-19 when compared to infections in general due to their CeD (56.1% vs 26.7%, P < 0.0001). Consequently, 34.8% reported taking extra COVID-19 precautions as a result of their CeD. Members of celiac associations were less likely to perceive an increased risk of COVID-19 when compared to non-members (49.5% vs 57.4%, P < 0.0001). Older age (aOR: 0.99; 95%CI: 0.99 to 0.99, P < 0.001), male sex (aOR: 0.84; 95%CI: 0.76 to 0.93, P = 0.001), and strict adherence to a GFD (aOR: 0.89; 95%CI: 0.82 to 0.96, P = 0.007) were associated with a lower perception of COVID-19 risk and the presence of comorbidities was associated with a higher perception of COVID-19 risk (aOR: 1.38; 95%CI: 1.22 to 1.54, P < 0.001).CONCLUSIONOverall, high levels of risk perceptions, such as those found in patients with CeD, may increase an individual’s pandemic-related stress and contribute to negative mental health consequences. Therefore, it is encouraged that public health officials maintain consistent communication with the public and healthcare providers with the celiac community. Future studies specifically evaluating mental health in CeD could help determine the consequences of increased risk perceptions in this population.     

The positive impact of social media on health behavior towards the COVID-19 pandemic in Bangladesh: A web-based cross-sectional study

BackgroundHealth information has a profound impact on developing awareness and ultimately preventing the burden of coronavirus disease-2019 (COVID-19) pandemic, but study in Bangladesh is lacking.AimsTherefore, this study was conducted to investigate the impact of information from social media and television in developing health awareness among people amid the COVID-19 pandemic.MethodsData was collected during December 10, 2020 to February 10, 2021 from 1808 people. Data was collected by using questionnaire about information source and their impact on COVID-19 related health measures. Pearson's correlation analyses was conducted.ResultsFemale (52%, 937 of 1808) was the most prevalent sex and the mean age was 24 ± 3.9 years. Most of the social media users were students (63%, 1131 of 1808). Social media (53%, 959 of 1808) and television (44%, 800 of 1808) were the most popular sources and Facebook (66.5%, 1203 of 1808) was the most common source of getting health information. About 87% people received health information on social media and television. Users of social media had about 3 times more likelihood to follow the health rules. About 80% participants who used social media followed the health measures after 0–28 days of getting the information. The strongest correlation was found between social distancing and the information on television (r = 0.943).ConclusionStrong correlation of health information was present among the participants in building awareness about taking preventive measures. This is the first study to describe the positive influence of information amid COVID-19 in Bangladesh.     

Psychological impact of COVID-19 pandemic on chronic disease patients in Dessie town government and private hospitals,Northeast Ethiopia

Background and aimsThe novel corona virus disease which was first detected in China, December 2019 is caused by severe acute respiratory syndrome corona virus 2. In Ethiopia, the number of infected peoples has been increased from day to day, despite government mitigation measures. But in our country the psychological impact of COVID-19 on patients with chronic diseases was unknown. Hence, this study was aimed to assess the psychological impact of COVID-19 and its associated factors among chronic disease patients.MethodsA facility based cross-sectional study design was conducted among 413 chronic disease patients in Dessie town government and private hospitals from July 20 to August 5, 2020. Impact of event scale revised questionnaire was used for data collection. Both binary and multivariable logistic regression analyses were utilized to show the association between outcomes and independent variables. In multivariable analysis, significant association was declared at p-value of <0.05.ResultsOverall, COVID-19 had abnormal psychological impact on 22.8% (95% CI: 18.6–27.1) of chronic disease patients. Age, sex, duration of chronic disease, respiratory symptoms and having no social support were factors for abnormal psychological impact.ConclusionCOVID-19 had abnormal psychological impact on one-fourth of chronic disease patients. Therefore, the government, health professionals and researchers should contribute to prevent the psychological impact ofCOVID-19 on chronic disease patients.     

Preparedness for establishing COVID-19 services during acute emergency of COVID-19 pandemic: Experience of a tertiary care TB and respiratory diseases hospital

BackgroundThe ongoing coronavirus disease 2019 (COVID-19) calls for setting up of well-equipped and dedicated health facilities to manage sick patients while protecting healthcare workers and the environment. An ideal high-level isolation unit requires a high level of administrative commitment, availability of space, human resource and logistics.MethodThe experience of setting up COVID-19 care facilities on a noticeably short period in a tertiary TB and respiratory diseases institute in wake of the COVID-19 pandemic is being shared here.ResultAll the essential COVID-19 services were set up in record time of 8 days. A total of 115 COVID-19 patients were admitted. Out of these 89 patients were discharged in a satisfactory condition. There were 19 deaths, and 4 patients became critical and had to be referred to level 3 facility for ICU care.ConclusionThis experience will help other hospitals in planning out the strategies and solve the difficulties they may face while opening a COVID-19 care facility under limited resources on an urgent basis.     

Hypertension is a clinically important risk factor for critical illness and mortality in COVID-19: A meta-analysis

AimsAs reported, hypertension may play an important role in adverse outcomes of coronavirus disease-2019 (COVID-19), but it still had many confounding factors. The aim of this study was to explore whether hypertension is an independent risk factor for critical COVID-19 and mortality.Data synthesisThe Medline, PubMed, Embase, and Web of Science databases were systematically searched until November 2020. Combined odds ratios (ORs) with their 95% confidence interval (CIs) were calculated by using random-effect models, and the effect of covariates was analyzed using the subgroup analysis and meta-regression analysis. A total of 24 observational studies with 99,918 COVID-19 patients were included in the meta-analysis. The proportions of hypertension in critical COVID-19 were 37% (95% CI: 0.27 ?0.47) when compared with 18% (95% CI: 0.14 ?0.23) of noncritical COVID-19 patients, in those who died were 46% (95%CI: 0.37 ?0.55) when compared with 22% (95% CI: 0.16 ?0.28) of survivors. Pooled results based on the adjusted OR showed that patients with hypertension had a 1.82-fold higher risk for critical COVID-19 (aOR: 1.82; 95% CI: 1.19 ? 2.77; P = 0.005) and a 2.17-fold higher risk for COVID-19 mortality (aOR: 2.17; 95% CI: 1.67 ? 2.82; P < 0.001). Subgroup analysis results showed that male patients had a higher risk of developing to the critical condition than female patients (OR: 3.04; 95%CI: 2.06 ? 4.49; P < 0.001) and age >60 years was associated with a significantly increased risk of COVID-19 mortality (OR: 3.12; 95% CI: 1.93 ? 5.05; P < 0.001). Meta-regression analysis results also showed that age (Coef. = 2.3×10^?2, P = 0.048) had a significant influence on the association between hypertension and COVID-19 mortality.ConclusionsEvidence from this meta-analysis suggested that hypertension was independently associated with a significantly increased risk of critical COVID-19 and inhospital mortality of COVID-19.     

Vitamin D concentrations and COVID-19 infection in UK Biobank

Background and aimsCOVID-19 and low levels of vitamin D appear to disproportionately affect black and minority ethnic individuals. We aimed to establish whether blood 25-hydroxyvitamin D (25(OH)D) concentration was associated with COVID-19 risk, and whether it explained the higher incidence of COVID-19 in black and South Asian people.MethodsUK Biobank recruited 502,624 participants aged 37–73 years between 2006 and 2010. Baseline exposure data, including 25(OH)D concentration and ethnicity, were linked to COVID-19 test results. Univariable and multivariable logistic regression analyses were performed for the association between 25(OH)D and confirmed COVID-19, and the association between ethnicity and both 25(OH)D and COVID-19.ResultsComplete data were available for 348,598 UK Biobank participants. Of these, 449 had confirmed COVID-19 infection. Vitamin D was associated with COVID-19 infection univariably (OR = 0.99; 95% CI 0.99–0.999; p = 0.013), but not after adjustment for confounders (OR = 1.00; 95% CI = 0.998–1.01; p = 0.208). Ethnicity was associated with COVID-19 infection univariably (blacks versus whites OR = 5.32, 95% CI = 3.68–7.70, p-value<0.001; South Asians versus whites OR = 2.65, 95% CI = 1.65–4.25, p-value<0.001). Adjustment for 25(OH)D concentration made little difference to the magnitude of the association.ConclusionsOur findings do not support a potential link between vitamin D concentrations and risk of COVID-19 infection, nor that vitamin D concentration may explain ethnic differences in COVID-19 infection.     

Influenza Vaccine: Influenza vaccine during the 2019–2020 season and COVID-19 risk: A case-control study in Québec

BackgroundWe carried out a case-control study that examined whether receipt of the inactivated influenza vaccine during the 2019–2020 season impacted on the risk of coronavirus disease 2019 (COVID-19), as there was a concern that the vaccine could be detrimental through viral interference.MethodsA total of 920 cases with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (diagnosed between March and October 2020) and 2,123 uninfected controls were recruited from those who were born in Québec between 1956 and 1976 and who had received diagnostic services at two hospitals (Montréal and Sherbrooke, Québec). After obtaining consent, a questionnaire was administered by phone. Data were analyzed by logistic regression.ResultsAmong healthcare workers, inactivated influenza vaccine received during the previous influenza season was not associated with increased COVID-19 risk (AOR: 0.99, 95% CI: 0.69–1.41). Among participants who were not healthcare workers, influenza vaccination was associated with lower odds of COVID-19 (AOR: 0.73, 95% CI 0.56–0.96).ConclusionWe found no evidence that seasonal influenza vaccine increased the risk of developing COVID-19.     

Clinical presentation and mortality risk factors for COVID-19 among diabetic patients in a tertiary care center in South India

BackgroundNon-communicable diseases (NCD) like hypertension, diabetes, cardiovascular and cerebrovascular diseases are the most common comorbidities among COVID-19 patients. The clinical presentation and mortality pattern of COVID-19 are different for patients with comorbidities and without comorbidities.ObjectiveTo determine the clinical presentation of COVID-19 and risk factors for COVID-19 mortality among diabetic patients in a tertiary care hospital in South India.MethodsA record-based cross-sectional study was conducted by reviewing the case records of COVID-19 patients admitted for treatment from June 2020 to September 2020 in a tertiary care centre in South India. Potential risk factors for COVID-19 mortality were analysed using univariate binomial logistic regression, generalized linear models (GLM) with the Poisson distribution. Survival curves were made using the Kaplan–Meier method.ResultsOut of 200 COVID-19 patients with diabetes with a mean (SD) age of 56.1 (11.8) years, 61% were men. The median survival time was slightly lesser in male COVID-19 patients (15 days) as compared to female patients (16 days). The risk of mortality among COVID-19 patients with diabetes is increased for patients who presented with breathlessness (aRR = 4.5 (95% CI: 2.3–8.8)), had positive history of smoking (aRR = 1.9 (95% CI: 1.1–3.8)), who had CKD (aRR = 1.8 (95% CI: 1.1–2.8)) and who had cardiac illness (aRR = 1.6 (95% CI: 0.9–2.7)).ConclusionDiabetes patients with COVID-19 need to be given additional care and monitoring especially if they present with breathlessness, positive history of smoking, cardiac illness and, CKD. Public health campaigns and health education activities to control smoking is needed to reduce the COVID-19 mortality in diabetes patients.     

Awareness regarding COVID-19 and problems being faced by young adults with type 1 diabetes mellitus amid nationwide lockdown in India: A qualitative interview study

AimsTo assess the awareness about COVID-19 and the problems being faced by young adults with T1DM amid nationwide lockdown in India.MethodsA cross-sectional telephone-based qualitative interview study was conducted in young adults (aged 18–30 years) with T1DM amid lockdown. Following verbal consent, participants were asked 8 open-ended questions, 5 on awareness about COVID-19 and 3 catering to problems being faced concerning diet, physical activity and treatment amid lockdown. On average, 3 interviews were conducted per day with each lasting for 15?20 min. Interviews were recorded, transcribed and analyzed by qualitative content analysis.ResultsThirty-two participants were interviewed; after exclusion of two poorly recorded interviews, 30 were finally analyzed. Mean age of participants was 22.4 ± 4.0 years (M:F = 8:7). Only 30%, 40% and 53% of participants were aware of modes of transmission (respiratory droplets and fomites), cardinal symptoms (fever, cough and breathing difficulty) and means of prevention (staying indoors, social distancing and regular hand washing), respectively. Majority of participants were unaware of additional risks associated with COVID-19 in diabetes mellitus. Most participants could continue with their routine diet and prescribed treatment regime, however, 90% reported a reduction in physical activity and 72% experienced worsening of glycemic control amid lockdown.ConclusionsYoung adults with T1DM lack adequate awareness about COVID-19. Increasing awareness and imparting diabetes self-management education via digital/print media is needed.     

Insomnia,Poor Sleep Quality and Sleep Duration,and Risk for COVID-19 Infection and Hospitalization

BackgroundMedical comorbidities increase the risk of severe acute COVID-19 illness. Although sleep problems are common after COVID-19 infection, it is unclear whether insomnia, poor sleep quality, and extremely long or short sleep increase risk of developing COVID-19 infection or hospitalization.MethodsThe study used a cross-sectional survey of a diverse sample of 19,926 US adults.ResultsCOVID-19 infection and hospitalization prevalence rates were 40.1% and 2.9%, respectively. Insomnia and poor sleep quality were reported in 19.8% and 40.1%, respectively. In logistic regression models adjusted for comorbid medical conditions and sleep duration but excluding participants who reported COVID-19-associated sleep problems, poor sleep quality, but not insomnia, was associated with COVID-19 infection (adjusted odds ratio [aOR] 1.16; 95% CI, 1.07-1.26) and COVID-19 hospitalization (aOR 1.50; 95% CI, 1.18-1.91). In comparison with habitual sleep duration of 7-8 hours, sleep durations <7 hours (aOR 1.14; 95% CI, 1.06-1.23) and sleep duration of 12 hours (aOR 1.61; 95% CI, 1.12-2.31) were associated with increased odds of COVID-19 infection. Overall, the relationship between COVID-19 infection and hours of sleep followed a quadratic (U-shaped) pattern. No association between sleep duration and COVID-19 hospitalization was observed.ConclusionIn a general population sample, poor sleep quality and extremes of sleep duration are associated with greater odds of having had a COVID-19 infection; poor sleep quality was associated with an increased requirement of hospitalization for severe COVID-19 illness. These observations suggest that inclusion of healthy sleep practices in public health messaging may reduce the impact of the COVID-19 pandemic.     

Emotions,Perceptions and Health Behaviors of Adult Congenital Heart Disease Patients during COVID-19 in New York City

Background: Adults with congenital heart disease (ACHD) have increased prevalence of mood and anxiety disorders. There are limited data regarding the influence of the COVID-19 pandemic on the mental health and health behaviors of these patients. Objective: The purpose is to evaluate the perceptions, emotions, and health behaviors of ACHD patients during the COVID-19 pandemic. Methods: In this cross-sectional study of ACHD patients, we administered surveys evaluating self-reported emotions, perceptions and health behaviors. Logistic regressions were performed to determine the adjusted odds of displaying each perception, emotion and health behavior based on predictor variables. Results: Ninety-seven patients (mean age 38.3 years, 46.4% female, 85.6% moderate or complex lesion) completed the survey. The majority of patients reported feeling moderately or very sad (63.1%), and 48.4% of patients identified themselves as feeling moderately or very anxious. The majority of patients perceived their risk of COVID-19 as moderate or high. Females were more likely to report feeling sad and anxious (95% CI 1.06–10.96, p-value 0.039, and 95% CI 1.44–15.30, p-value = 0.012, respectively), and were associated with higher odds of having a perceived increased risk of COVID-19 (95% CI 1.33–10.59, p-value 0.012). There was no association between ACHD anatomic or physiologic classification and perceptions, emotions and health behaviors. Conclusions: Females were more likely to report feeling sad, anxious and an increased risk of COVID-19 in comparison to males. These findings indicate the need for mental health support and promotion of health behaviors during the pandemic amongst all ACHD patients, regardless of underlying condition.     

Establishment of a COVID-19 Recovery Unit in a Veterans Affairs Post-Acute Facility

Coronavirus disease 2019 (COVID-19) is now an epidemic of global proportion, with major adverse impacts on older adults, persons with chronic diseases, and especially residents of long-term care facilities. This health catastrophe has challenged healthcare facilitiesʼ capacity to deliver care to not only COVID-19 patients but all patients who need hospital care. We report on a novel approach of utilizing long-term care beds at a Department of Veterans Affairs healthcare facility for managing recovering COVID-19 patients. J Am Geriatr Soc 68:2163–2166, 2020.     

Impact of COVID-19 lockdown on people living with diabetes: Experience from a low-middle income country in South Asia

AimsCOVID-19 lockdown imposes many challenges to patients with diabetes. We aimed to assess the impact of COVID-19 lockdown on health-related behavior and disease control among patients with diabetes.Materials and methodsA cross-sectional study was conducted among adults with diabetes attending a diabetes clinic in Colombo, Sri Lanka in June-July 2020. Lifestyle and disease control changes before and during the lockdown, were determined using an interviewer-administered questionnaire and review of medical records.ResultsAmong 1727 participants mean HbA1c decreased by 0.30% (95% CI 0.24?0.36, p < 0.001). HbA1c improved in 37.6% but deteriorated in 18.8%. Male sex (OR 1.36, 95% CI 1.10–1.67), better education (OR 1.10, 95% CI 1.01–1.20) and being employed (OR 1.08, 95% CI 1.00–1.16) were sociodemographic predictors of improved control. Better dietary adherence (OR 1.55, 95% CI 1.13–2.12), night-time sleep (OR 1.46, 95% CI 1.13–1.88) and indoor exercise (OR 1.62, 95% CI 1.23–2.07) were behavioural determinants of improved glycaemia. Decreases in self-monitoring of blood glucose (OR 1.45, 95% CI 1.09–1.93), exercise (OR 1.7, 95% CI 1.32–2.20), medication use (OR 1.95, 95% CI 1.37–2.78), dietary adherence (OR 1.72, 95% CI 1.32–2.26) and family income (OR 1.45, 95% CI 1.12–1.88) predicted worsening glycaemia. Only 4.1% used telehealth services; 83.1% of them reported good satisfaction.ConclusionsMean HbA1c improved during the lockdown. Overall, 37.6% of participants improved their glycaemic control. Well-educated employed men were more likely to improve glycaemic status. Improving diabetes control through healthy lifestyle practices and self-monitoring are feasible even in resource limited settings.     

Metformin is associated with lower hospitalizations,mortality and severe coronavirus infection among elderly medicare minority patients in 8 states in USA

Background and aimsMetformin has antiviral and anti-inflammatory effects and several cohort studies have shown that metformin lower mortality in the COVID population in a majority white population. There is no data documenting the effect of metformin taken as an outpatient on COVID-19 related hospitalizations. Our aim was to evaluate if metformin decreases hospitalization and severe COVID-19 among minority Medicare patients who acquired the SARS-CoV2 virus.MethodsWe conducted a retrospective cohort study including elderly minority Medicare COVID-19 patients across eight states. We collected data from the inpatient and outpatient electronic health records, demographic data, as well as clinical and echocardiographic data. We classified those using metformin as those patients who had a pharmacy claim for metformin and non-metformin users as those who were diabetics and did not use metformin as well as non-diabetic patients. Our primary outcome was hospitalization. Our secondary outcomes were mortality and acute respiratory distress syndrome (ARDS).ResultsWe identified 1139 COVID-19 positive patients of whom 392 were metformin users. Metformin users had a higher comorbidity score than non-metformin users (p < 0.01). The adjusted relative hazard (RH) of those hospitalized for metformin users was 0.71; 95% CI 0.52–0.86. The RH of death for metformin users was 0.34; 95% CI 0.19–0.59. The RH of ARDS for metformin users was 0.32; 95% CI 0.22–0.45. Metformin users on 1000 mg daily had lower mortality, but similar hospitalization and ARDS rates when compared to those on 500–850 mg of metformin daily.ConclusionsMetformin is associated with lower hospitalization, mortality and ARDS among a minority COVID-19 population. Future randomized trials should confirm this finding and evaluate for a causative effect of the drug preventing disease.